Alfred Health Annual Report 2016-2017

124 Pages·2017·10.61 MB·English

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Alfred Health 1
Our story

Across our diverse organisation, we value and Contents
respect life from beginning to end.
2 About Alfred Health

We provide treatment, care and compassion to the people of Melbourne and Victoria.
Our research and education programs advance the science of medicine and health and 4 Chair and Chief Executive’s
contribute to innovations in treatment and care. Through partnerships we build our Year in Review
knowledge and share it with the world.
7 Our employees
Our purpose 12 Our patients
To improve the lives of our patients and their families, our communities and humanity. 17 Delivering quality care
30 Performance
Our beliefs
39 Research through partnership
Patients are the reason we are here – they are th e focus of what we do.
How we do things is as important as what we do.
42 Projects and infrastructure
Respect, support and compassion go hand in hand with knowledge, skills and
wisdom. Safety and care of patients and staff are fundamental. 45 Community and environment
Excellence is the measure we work towards every day. Through research and
education we set new standards for tomorrow. 49 Governance
We work together. We all play vital roles in a team that achieves extraordinary results.
58 Disclosure index
We share ideas and demonstrate behaviours that inspire others to follow.
59 Financial Statements
About this report
67 Notes to the Financial
statements
This annual report outlines the operational and financial performance for
Alfred Health from 1 July 2016 to 30 June 2017. We have aimed to include all
our reportable data in the one publication, so information normally found
in the Quality Account is included here.
There were two relevant Ministers for the period. The Minister for Health
was the Hon. Jill Hennessy MP and the Minister for Mental Health,
Minister for Housing, Disability and Ageing, the Hon. Martin Foley MP.
Alfred Health is a metropolitan health service established under section 181
of the Health Services Act 1988 (Vic) in June 2000.
This report is available on line at: alfredhealth.org.au
Glossary
DHHS Department of Health and Human Services
PCF Patients Come First
RAP Reconciliation Action Plan
GEM Geriatric Evaluation and Management
STRIDE Service To Reduce Risk, Improve Independence and Decrease Emergency
Front cover: No matter the challenges and high demand for our care, patients are always our main focus.
2 Annual Report 2016-17
About Alfred Health
Alfred Health is one of
Highlights
Australia’s major health
106,683 services, with three
Emergency presentations hospital campuses –
(Alfred and Sandringham)
The Alfred, Caulfield
111,923
episodes of inpatient care Hospital and Sandringham
11,665 Hospital – as well as
elective surgeries performed
several clinics and a range
96 20 of community-based
lung transplants heart transplants
services.
97.4 per cent
of elective waitlist patients treated
within clinically recommended times We care for people, from children to the
elderly, across Victoria. With a broad
1,498 range of statewide programs, our services
major trauma patients reach far beyond our local community of
southern and Bayside Melbourne to care
8,002
for Victorians.
total trauma patients
With a growing population throughout
9,016 the state, we are constantly expanding
employees our care – in the community, in the home
and in hospital. Our work is not confined
524 to lifesaving procedures; it extends to
volunteers intensive rehabilitation to help our patients
regain as much function, independence
and wellbeing as possible.
As a teaching institution, clinical research and education are at the forefront of our
practice. With acutely unwell patients, we are in the best position to translate medical
research into clinical practice. We also partner with key stakeholders, including
Metropolitan Ambulance, CFA, Victoria Police and other specialists to ensure the best
and latest care for our patients.
Developing our staff is part of our commitment to excellence. Patients are at the centre
of all we do and we continue to seek ways to improve the patient experience.
Three hospital campuses
The Alfred, a major tertiary referral hospital, is best known as
one of Australia’s busiest emergency and trauma centres and
home to many statewide services including the Victorian Adult
Burns Service, Heart and Lung Transplant Service and Psychiatric
Intensive Care Service. This site is also home to the Alfred Medical
Research and Education Precinct.
Caulfield Hospital specialises in community services, rehabilitation,
aged care and aged mental health. The hospital delivers many
services through outpatient and community-based programs and
plays a statewide role in providing rehabilitation services, which
includes the Acquired Brain Injury Rehabilitation Centre.
Sandringham Hospital is community focused, providing hospital
healthcare needs for the local area through emergency, paediatrics,
general medicine and outpatient services. The hospital works
closely with the Royal Women’s Hospital onsite and local
community healthcare providers.
Image (left): Staying fit and well is the aim of Activate programs held at Caulfield Hospital for older people in our community.
Alfred Health 3
14
Statewide Services
Community services and clinics
Melbourne Sexual Health Centre has
dedicated clinics for men and women,
onsite testing for sexually transmitted
infections and provides counselling, advice
and health information.
Community clinics meet the growing expectations of our
patients for treatment in their communities or at home. We have
developed numerous clinics to deliver this care, including new
services such as Hope (a psychiatric program aiming to reduce
suicide rates), a new drug and alcohol service, rehabilitation
programs and we are continuing important work with the Hospital
Admission Risk Program.
Secondary Catchment (297,000+)
Our catchments
Alfred Health’s catchment reflects our role in the provision of tertiary,
sintcaltuedweisd teh ea nlodc aslp geocviaelrinsmede nhte aarletha ss oefr vBiacyessid. Oe, uGrl elonc Eailr ac,a Mtcehlmboeunrnt e, Primary Catchment (380,000+)
Port Phillip, Kingston and Stonnington. This primary catchment
(which now numbers over 650,000) has grown by approximately The Alfred
15 per cent (75,000 people) between 2011 and 2016.
Our statewide services provide care to those residing around
Caulfield
Victoria and Australia.
Hospital
Alfred Health’s
Clinical services Primary and
Secondary
We provide the most comprehensive range of adult specialist
catchments
medical and surgical services in Victoria. We offer almost every
Sandringham
form of medical treatment across our multiple sites and three
hospital campuses. Hospital
Clinical services include:
• Aged care (Geriatric Evaluation and Management, Acute) Source: Adapted from an
• Allied health Australian Bureau of Statistics map
• Cancer care (Bone Marrow Transplantation, Radiotherapy,
Oncology, Haematology, Cancer Surgery)
• Cardiothoracic services (Heart and Lung Transplantation,
Cardiology, Cardiac Surgery, Cardiac Rehabilitation, Alfred Health National Service
Respiratory Medicine, Thoracic Surgery, Adult Cystic Fibrosis) • Paediatric Lung Transplant Service
• Emergency Medicine, Intensive Care, Burns and Adult Major Trauma
• Ear, Nose and Throat (Head and Neck Surgery) Alfred Health Statewide Services
• Gastrointestinal (Gastroenterology, Gastrointestinal Surgery) 1. Bariatric Service
• General Medicine
2. Clinical Haematology and Haemophilia Services
• General Surgery
3. Cystic Fibrosis Service
• Neurosciences (Neurology, Neurosurgery)
• Ophthalmology 4. Heart and Lung Transplant Service
• Orthopaedics 5. Hyperbaric Medicine Service
• Palliative care 6. Major Trauma Service
• Pathology (Anatomical, Clinical Biochemistry, Laboratory
7. Malignant Haematology and Stem Cell
Haematology, Microbiology)
Transplantation Service
• Pharmacy
• Psychiatry (adult, child, adolescent, youth, aged) 8. Psychiatric Intensive Care Service
• Radiology and Nuclear Medicine 9. Sexual Health Service
• Rehabilitation (Acquired Brain Injury Rehabilitation Centre, 10. Specialist Rehabilitation Service
amputee, cardiac, spinal, neurological, orthopaedic)
11. Victorian Adult Burns Service
• Renal services (Nephrology, Haemodialysis, Renal Transplantation)
12. Victorian HIV/AIDS Service
• Specialist medicine (Asthma, Allergy and Clinical
13. Victorian Melanoma Service
Immunology, Dermatology, Endocrinology/Diabetes,
Hyperbaric, Infectious Diseases, Rheumatology) 14. Victorian Neuropathology Laboratory Service
• Specialist surgery (Dental, Faciomaxillary, Plastic, Vascular)
• Urology
4 Annual Report 2016-17
Chair and Chief Executive’s
Year in Review
A strong performance The Year in Review
by a dedicated team
In a challenging year, the Alfred Health team responded with professionalism and
compassion to deliver the best possible care for our community.
As the new Chair of one of Australia’s
leading health services, I am delighted to Our emergency, trauma and critical care capability was needed more than ever before:
present Alfred Health’s Annual Report for • More than 106,000 people presented at our two emergency departments and we
2016-17. treated more than 8,000 trauma patients.
• Almost 98 per cent of our elective waitlist patients were treated within clinically
In my short time in this role, I have been
recommended times.
impressed by the culture of care evident
throughout Alfred Health and the dedication • More than 11,300 surgeries were completed, including additional surgical work
of staff to care for people locally as well that helped ease elective surgery waiting lists at other public hospitals.
as people Victoria-wide who are treated
There was growth across almost all activity indicators, with the health service
through 14 statewide services.
undertaking more than 111,000 episodes of patient care.
The results for 2016-17 speak to this
Importantly 95.6 per cent of Alfred Health patients rated their care as ‘good’,
dedication. It is a strong performance
‘very good’ or ‘exceptional’. And 96 per cent felt they were treated with respect
that carefully balances timely quality care
and dignity. These are essential markers of quality and care.
with expert clinical governance and sound
financial management. This excellent Importantly 95.6 per cent of Alfred Health patients rated their care as ‘good’,
performance has been sustained over ‘very good’ or ‘exceptional’. And 96 per cent felt they were treated with respect
many years. and dignity. These are essential markers of quality care.
I acknowledge the leadership of Helen This was achieved while delivering a surplus of $0.2million and continuing to exceed
Shardey as the former Chair and for the state’s requirements for hand hygiene, post-discharge follow-up, staff flu
her role in strengthening Alfred Health, as immunisations and cleaning standards.
well as Sara Duncan and David Shaw who
finished serving on the Board at the year end. Caring for all Victorians
Increased demand was seen across the many state-wide services we provide for our
Victorian community.
There was sustained growth in our major trauma program, with almost 1,500 patients
Michael Gorton
recovering from severe trauma, requiring our intensive care expertise. By comparison,
Chair
we treated 1,400 such major trauma patients in the previous year.
Alfred Health
There was a corresponding lift in the number of patients supported through our Rehabilitation
Michael Gorton 22 August 2017
Services at Caulfield Hospital. Our Acquired Brain Injury Unit, which opened in 2014,
Chair
now accounts for almost 40 per cent of all rehabilitation occupied bed days at Caulfield.
Through our heart and lung transplantation program, dozens of Australians were given a second
chance at life with our clinicians performing 96 lung, 20 heart and 28 kidney transplants.
Leading cardiac services
As the only Victorian health service able to provide the full range of adult cardiac care
from heart failure through to cardiac rehabilitation, The Alfred continued to treat some
of the most complex cardiac cases in the state. Due to our specialisation and increased
regional referrals, cardiac admissions have grown by 42 per cent over the last five years.
Our constant improvement in cardiac clinical practice – as with many of our other
specialities – is a result of direct involvement in global research and clinical trials. As a
case in point, this year, we were the first hospital in Australia to participate in trialling
Trans catheter Aortic Valve Implantation (TAVI). If successful, this could eliminate the
need for open heart surgery for many patients.
Challenges
Growing demand – particularly for acute inpatient beds – challenged the health service.
An additional 33 inpatient beds were opened during the year. At times limited bed
capacity reduced our ability to provide timely care.
To address capacity in the short term, planning is underway for a new ward on the
fifth floor of The Alfred’s main ward block – the last remaining ward space available for
development. Planned to open in 2018, this new ward will support the early recovery of
trauma patients.
Alfred Health 5
Day Procedure Centre: The go ahead Supporting vulnerable • First Chair of Oncology created in
for the Sandringham Hospital’s new Day honour of Tony Charlton, who spent
communities
Procedure Centre will also contribute more than 20 years supporting The
extra capacity. The specially-designed Alfred. Eminent researcher and clinician,
Partnerships underpinned our response to
facility, due to open in 2018, will free Professor John Zalcberg OAM accepted
better supporting our more disadvantaged
up bed space for patients from the the inaugural position. The role will
communities.
emergency department. foster the transfer of research into
This year we started formulating the basis clinical practice, making a positive
The centre has been made possible through
of our Vulnerable Persons Strategy, by difference to the lives of thousands
a successful local capital appeal supported
bringing together our staff and consumers of Victorians fighting cancer.
by the local community and businesses,
as well as many community and government
with the Victorian State Government
generously matching the funds raised. agencies including Victoria Police. This Connected care
work will continue in 2017-18 as we develop
Infrastructure: Ageing infrastructure a detailed action plan and related programs. Central to Alfred Health’s strategic plan is
presented another challenge during the our eTQC (electronic Total Quality Care)
More than one-in-10 individuals
year. Flooding from thunderstorms in initiative. This five-year program (2016–21)
presenting to The Alfred’s emergency
late December damaged an operating will transition the health service to an
department face insecure housing.
theatre as well as the recovery suite at integrated electronic medical information
The Alfred. This incident demonstrated Through our mental health service, we system, digitising our health system as
the infrastructure – much of which dates continued partnerships with organisations a result. It will improve data quality and
back to the late 1960s – struggles with accessibility and better support how we
specialising in supporting people
significant weather events. deliver clinical care.
experiencing homelessness and drug and
The Victorian Government generously alcohol addiction. This work improves eTQC is a significant undertaking that
provided $9.4million in funding to help our understanding of our community and relies on engaging the whole organisation
address the stormwater and other essential opens patient pathways post-discharge. in its development and delivery. Substantial
infrastructure issues in the short term. progress was made during the year and
With the help of Reconciliation Australia
the first phase of eTQC is due to go live in
There were significant infrastructure our local elders and staff we developed
late 2018.
achievements during the year, particularly our Reconciliation Action Plan (RAP).
the redevelopment of The Les and Eva Erdi The RAP, which will be launched early
Emergency and Trauma Centre at The next year, aims to create enduring Support
Alfred, which is due to open in early 2018. relationships with our local Aboriginal
My gratitude goes to the unstinting
community built on the basis of respect
support of my Board and Executive team
Safety and wellbeing of staff and understanding.
during the year.
One of the most concerning challenges Particular thanks must go to our outgoing
Research and patient care
in healthcare at present is the increasing chair Ms Helen Shardey, who for the past
incidence of aggression and violence Clinical research goes hand in hand with six years, has supported, guided and
towards staff while they provide care. clinical practice at Alfred Health, with this believed in Alfred Health. We also warmly
approach bringing major benefits to our welcome our new chair, Michael Gorton
Our staff have the unequivocal right to a
patients. Major achievements this year to his role.
safe workplace and there is zero tolerance
included:
for aggressive or violent behaviour from To our community – your generosity
patients or the community towards staff. • Progression on landmark peanut whether it is through volunteering,
It is also an issue of patient care as we vaccine trials led by respiratory supporting our many events or becoming
know staff welfare and quality patient physician Professor Robyn O’Hehir. a donor, truly makes a difference to our
care go hand-in-hand. The treatment uses new technology to patients and our staff every day.
reset the immune system to tolerate
In early March we launched an internal And to our frontline staff – your unfailing
peanuts without any allergic reactions.
campaign, encouraging staff to report commitment to our patients is the bedrock
• Australia’s first dedicated blood
these incidents to the health service of our great public healthcare service.
cancer research centre established
and Victoria Police. In addition, we fully
by The Alfred and Monash University
endorsed and promoted the Victorian
thanks to a $1.2 million grant from
Government’s excellent Worksafe
the Australian Cancer Research
campaign that tackles this issue. Prof Andrew Way
Foundation (ACRF).
Chief Executive
Our stance on building a respectful
• Expansion of PrepX: The ground-
Alfred Health
culture and improving patient safety
breaking study which is providing
in surgery was further strengthened people at risk of HIV with access Andrew Way 22 August 2017
under a new agreement with the Royal to the life-changing medication, Chief Executive
Australasian College of Surgeons. The
Pre-exposure prophylaxis (PrEP).
Memorandum of Understanding commits
The study, supported by The Alfred,
both organisations to work closely to
the Victorian AIDS Council and the
address issues around discrimination,
Victorian Government expanded into
bullying and sexual harassment in surgery
rural and regional sites.
and the broader healthcare sector.
6 Annual Report 2016-17
Key indicators 2016–17
Alfred Emergency Department presentations Sandringham Emergency Department presentations
(including Urgent Care Centre at Sandringham)
3% up almost 3 per cent 10.6% 10.6 per cent increase 4.3% up almost 4.3 per cent 24.7% 24.7 per cent increase
1 YEAR on last year and... 4 YEARS over four years 1 YEAR on last year and... 4 YEARS over four years
70,000 50,000
465000,,,000000000 58,822 60,345 62,614 63,248 65,058 4300,,000000 33,373 34,824 38,355 39,913 41,625
30,000 20,000
20,000
10,000
10,000
0 0
2012-13 2013-14 2014-15 2015-16 2016-17 2012-13 2013-14 2014-15 2015-16 2016-17
GEM (older patients at Caulfield Hospital) bed days, Emergency Operating Room procedures
including GEM at Home,– up 30 per cent over five years (Alfred)
30% up 30 per cent over five years 24% up 24 per cent over five years
5 YEARS 5 YEARS
50,000 8,000
4300,,000000 5,763 38,722 38,879 5,291 46,389 657,,,000000000 6,395 6,322 7,204 7,769 7,920
3 3 4,000
20,000 3,000
2,000
10,000
1,000
0 0
2012-13 2013-14 2014-15 2015-16 2016-17 2012-13 2013-14 2014-15 2015-16 2016-17
Percentage of elective waitlist patients treated
within clinically recommended times (Alfred Health)
90% consistently over 90 per cent for five years.
5 YEARS
100%
% % %
80% 91.7% 93.1% 96.6 97.9 97.4
60%
40%
20%
0%
2012-13 2013-14 2014-15 2015-16 2016-17
Alfred Health 7
Our employees
Ensuring our staff have a safe and healthy workplace
has been an ongoing focus, as well as engaging
staff in this process. System improvements were
also central, including the development of a new
Occupational Health and Safety strategy.
Recruiting
Highlights
and retaining
9,016
We welcomed 2016 new employees.
employees as at 30 June
Headcount 547
length of service awards
Staff numbers have grown by 16 per cent
over the last five years, as services have
expanded and demand increased.
2012–13 2013–14 2014–15 2015–16 2016–17
7,741 7,989 8,432 8,570 9,016
2016 2017
Casual Full Part Grand Casual Full Part Grand
Time Time Total Time Time Total
Caulfield 137 614 723 1,474 144 646 761 1,551
Sandringham 368 91 314 773 387 96 331 814
The Alfred 561 2,786 2,976 6,323 590 2,931 3,130 6,651
Grand Total 1,066 3,491 4,013 8,570 1,121 3,673 4,222 9,016
Workforce (EFT)
Current Month FTE YTD FTE*
Hospitals Labour Category 2016 2017 2016 2017
1 Nursing 2,399 2,532 2,380 2,371
2 Administration/ Clerical 912 989 888 977
3 Medical Support 554 557 538 545
4 Hotel & Allied Services 189 207 195 211
5 Medical Officers 194 204 191 205
6 Hospital Medical Officers 509 531 503 537
7 Sessional Clinical 153 155 146 157
8 Ancillary Staff (Allied Health) 878 987 869 941
* The average EFT is calculated based on the weighted average of employees in each category in the 2016–17 year.
Image (right): An environment of great teamwork by our surgical teams brings positive results.
8 Annual Report 2016-17
Our employees
(continued)
Occupational We have also developed an Occupational WorkCover claims
Violence and Aggression Prevention
health and safety Action Plan, working with key internal A new system to more effectively manage
and external stakeholders. WorkCover claims and support staff to
return to work was implemented this year.
Long-term strategy Occupational violence statistics* 2016–17 InjuryConnect allows us to monitor and
improve return to work timeframes and
1. Workcover accepted claims 0.218
Every day our staff encounter challenging with an occupational claim management processes.
situations and circumstances that violence cause per 100 FTE
The majority of WorkCover claims this
can impact on their health, safety and
2. Number of accepted 0.02 year relate to manual handling injuries.
wellbeing at work. Workcover claims with
lost time injury with an
91 WorkCover standard claims
A long-term strategy has been approved occupational violence cause
to create a culture where staff are safe, per 1,000,000 hours worked.
Incident Type Number *
healthy and supported at work, focusing on: 3. Number of occupational 516
• injury prevention violence incidents reported Exposure to noise, chemicals, etc. 3
• staff wellbeing 4. Number of occupational 8.68 Hit or hit by, excluding violence 1
violence incidents reported
Mental stress 2
• healthy work environment per 100 FTE
Occupational violence 9
• supporting staff returning to work 5. Percentage of occupational 29%
following an incident or injury. violence incidents resulting Other 2
in a staff injury, illness or
Over the past 12 months, we: condition Slips, trips & falls 16
• completed a review of how manual * Figures include WorkCover claims awaiting Manual handling 58
handling and occupational violence confirmation of status by Worksafe as of 30 June 2017 Grand Total 91
issues are managed across the
Manual handling * Figures include claims awaiting Worksafe
organisation confirmation of status.
• developed and implemented an Our efforts to reduce injuries occurring
occupational violence prevention due to manual handling continue.
Health and wellbeing
and management training program This year we:
• established an organisational • developed local, individually tailored
We continue to foster a workplace where
commitment to prevent and programs to establish a positive safety
staff can be as healthy as possible so they
manage bullying and harassment. culture around manual handling activities
can continue to provide good patient care.
• expanded the existing SafeMoves Projects this year included:
Health and safety program beyond ward areas into
• A ‘Good News for Smokers’ campaign,
departments, including radiotherapy
representation encouraging staff to quit. This included
and cardiology
providing funded nicotine replacement
This year staff representation numbers on • introduced new methods to manage therapy and best practice individual or
occupational health and safety issues bariatric patients by updating group support. The result: 53 per cent
improved significantly, with 18 new Health organisational guidelines, purchasing of participants remained smoke free
and Safety Representatives (HSRs). new equipment like beds and hoists an average of five months later.
All HSRs underwent training programs, and held a Bariatric Interdisciplinary
• Expansion of our sit-to-stand
which included updates on legislative Study Day, which was attended by
program to include meeting rooms.
changes and occupational violence issues. healthcare professionals from across
Following the success of an initial
the state
trial, three sit-to-stand meeting
Occupational violence • upgraded our manual handling rooms have now been implemented
equipment, including the installation across our sites, encouraging staff
With violence a too frequent occurrence
of 26 overhead hoists in patient rooms to undertake standing meetings and
in healthcare, we have developed
to address an increase in injuries reduce sedentary behaviour.
extensive policies on the management
resulting from repositioning patients
of patient behaviour and advised staff • Promotion of active travel initiatives,
in bed or getting them in and out of
about support available for them through with the Active Travel Zone winning
bed. This equipment reduces the risk
counselling and with legal action, should a 2016 VicHealth award for
of injury to staff, while also providing
violence occur in the workplace. ‘Encouraging physical activity’.
a safe transfer method for patients.
• Enhanced health and fitness facilities
for staff, with new onsite providers
offering a wide range of services to
The Alfred and Caulfield Hospital
and outdoor training sessions in
development for Sandringham Hospital.